From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

From Duke Clinical Research Institute (K.S.P., S.J.L., M.A.G., A.F.H.) and Department of Medicine (K.S.P., A.F.H.), Duke University School of Medicine, Durham, NC; Stanford University School of Medicine, Palo Alto, CA (P.A.H.); Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL (C.W.Y.); and Geffen School of Medicine at University of California at Los Angeles (G.C.F.).

Sacubitril/valsartan was compared to enalapril in the PARADIGM-HF trial (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure [HF]), which was stopped early after an observed 20% reduction in the composite end point of cardiovascular death or HF hospitalization.1 The US Food and Drug Administration (FDA) approved sacubitril/valsartan for patients with HF with reduced ejection fraction (HFrEF) in July 2015. However, FDA labeling is broader than trial entry criteria, and the scope of potential sacubitril/valsartan use in HFrEF is not well understood. We used the GWTG-HF registry (Get With The Guidelines-Heart Failure) to characterize patients’ eligibility and potential barriers for sacubitril/valsartan initiation according to criteria set forth in FDA labeling and PARADIGM-HF. The GWTG-HF registry was started in 2005 by the American Heart Association to improve adherence to quality of care guidelines for patients hospitalized for HF. Patients were eligible for inclusion in the registry if they were admitted for worsening HF or developed significant HF symptoms during a hospitalization.2 We included GWTG-HF registry participants ≥18 years of age hospitalized with HFrEF (EF ≤40%) between January 1, 2011, and December 31, 2013. Patients were excluded if they had in-hospital death or any missing information for variables needed to determine …